A quick

Menstruation Menstruation is the periodic discharge of bloodand mucosal tissue from the inner lining of theuterus through the vagina due to, orderly cyclichormone production and parallel proliferation ofthe uterine lining preparing for implantation of theembryo. The time frame from the start of one menstrualepisode to the start of next menstrual episode iscalled Menstrual Cycle. The number of days the menstrual bleedingpersists is called menstrual Period.

The parameters of Normal

Menstruation Duration of flow 3-7 days

(average 4 days)

Cycle length 21 - 35 days

(average 29 days)

(28 days +/- 7 days}

Blood loss < 80 ml

(average 30-35 ml)

Any deviation from this

normal parameter isabnormal menstruation

When will we call it Abnormal

Menstruation??

Duration of flow

more than 7 days (If flow is normal) or

more than 5 days (if flow is heavy) Less than 2 days

Menstrual cycle is Less than 21 days More than 35 days

Flow is heavy blood loss of greater than 80 ml Passing of large blood clot during menstruation Enough flow to soak a pad or tampon every hour for 3consecutive hours. (Each soaked tampon holds 5ml of blood) Night time bleeding that requires getting up to change pads ortampons

Peri menopausal age

The problems of Classic terminology And the

move to refine it Over the past decade it has becomeabundantly clear that many terms used todescribe menstrual symptoms and causes ofabnormal menstrual bleeding are ill definedand confusing.

The problems of Classic terminology And the

move to refine it So, a formal initiative was established with aninternational workshop in Washington, D.C., in2005, Which yielded the FIGO (InternationalFederation of Gynecology and Obstetric)Classification in 2009 at Cape town. This Classification looks to refine the Illdefined Terminologies to a better defined welldemarcated territory of Newer TerminologyThat Is, ABNORMAL UTERINE BLEEDING

ABNORMAL UTERINEBLEEDING Abnormal Uterine Bleeding is defined asbleeding from the uterine corpus that isabnormal in regularity, volume, frequency, orduration and occurs in the absence ofpregnancy in women of reproductive age.

Caution Abnormal Uterine Bleeding excludes thefollowing situations: AUB Excludes Gravid patients. A pregnancy test is amust before trying out for AUB. AUB deals only with women of reproductive age thatis from definitive onset of Menstruation tomenopause. So, pre-pubertal bleeding or postmenopausal bleeding is not included in AUB. Lower genital tract bleeding due to any cause isopted out of AUB. So, cervical or vaginal tears ormalignancies must be excluded first.

Types of AUB Heavy Menstrual Bleeding Acute AUB is defined as an episode of heavy bleeding that, in theopinion of the clinician, is of sufficient quantity to requireimmediate intervention to prevent further blood loss

Chronic chronic AUB is defined as bleeding from the uterine corpusthat is abnormal in volume, regularity, and/or timing, andhas been present for the majority of the past 6 months

P- Polyp (AUB-P) Polyps are epithelial proliferationscomprised of a variable vascular,glandular, and fibromuscular andconnective tissue components andare often asymptomatic. Yet, it is generally accepted that atleast some polyps contribute to thegenesis of AUB.

For the basic classification system,

polyps are categorized as beingeither present or absent.

A- Adenomyosis (AUB-A) The relationship betweenadenomyosis and thegenesis of AUB is unclear,though undeniable.

As there exists both

sonographic and magneticresonance imaging (MRI)based diagnostic criteria,adenomyosis has beenincluded in theclassification system

L- Leiomyoma (AUB-L) An Important causeof AUB I has its ownprimary, secondaryand tertiaryclassification system

M- Malignancy & Hyperplasia (AUB-M)

Although relativelyuncommon, atypicalhyperplasia andmalignancy areimportant potentialcauses of, or findingsassociated with AUBand must be consideredin nearly all women ofreproductive age

O-Ovulatory dysfunction (AUB-O)

Ovulatory dysfunction can contribute to the genesisof AUB. Although most ovulatory disorders elude a definedetiology, many can be traced to Endocrinopathies(e.g. polycystic ovary syndrome, hypothyroidism,hyperprolactinemia, mental stress, obesity, anorexia,weight loss, or extreme exercise such as thatassociated with elite athletic training). Also, unexplained ovulatory disorders frequentlyoccur at the Extremes of reproductive age.

E- Endometrial (AUB-E) When AUB occurs in the context of predictable and cyclicmenstrual bleeding, typical of ovulatory cycles, andparticularly when no other definable causes areidentified, the mechanism is probably a primary disorderof the endometrium. Indeed, high-quality evidence has demonstrateddeficiencies in local production of vasoconstrictors suchas endothelin-1 and prostaglandin F2, and/oraccelerated lysis of endometrial clot because of excessiveproduction of plasminogen activator. the diagnosis of endometrial disorders should probablybe determined by exclusion of other identifiableabnormalities in women of reproductive age who seemto have normal ovulatory function.